Hospitals around the state — and around the country — are getting smaller.

They are fighting state and federal bureaucracies to obtain Medicare reimbursement. They’re paying higher prices for talent and technology. They’re shrinking physical plants to keep up with heat and maintenance. Their legal departments are primed for highpriced malpractice claims. And in the slow pace of reform, they continue to shoulder too much of the burden for the uninsured.

So — even as officials there say it’s not the case — a weak financial outlook at Parkview Adventist Medical Center makes it logical for them to seek a tie-up with Lewiston- based Central Maine Health Care, a company with which they have long had ties.

The question is not whether Parkview needs a lifeline, but who should be the entity that throws it to them.

Is it CMHC? Or is it Mid Coast Hospital, Brunswick’s other major hospital, which has its own, substantial financial challenges?

To answer that question, we ask two others:

What would provide the best chance at financial survival for a single Brunswick hospital, which is undeniably what this market will support?

What would best serve the health care needs of Mid-coast residents?

The state, through its Certificate of Need process, is in the process of answering the former question, but we aren’t at all sure they’re concerned about the latter.

That’s because the state has already thrown out a competing Certificate of Need application from Mid Coast that proposes a Mid Coast-Parkview merger. The CMHCParkview merger — approved unanimously by those two hospitals’ boards — is the only proposal the state is assessing.

We recognize these are private entities with certain rights of self-determination, but the state has a compelling interest in picking the right partner. So it’s unfortunate it has chosen to deal with only one bidder.

Mid Coast makes compelling arguments that control of medical facilities in Brunswick should remain in Brunswick, and that its plan would save millions by eliminating redundancies in operations, staffing, administration and facilities.

Yes, CMHC’s plan may yet turn out to be the best. It helped Rumford Hospital overcome a revenue shortage of about $1 million in 2009 to become $4.6 million in the black in 2010. Bridgton Hospital also posted profits of $3.1 million and $7.6 million, respectively, in 2009 and 2010, under CMHC leadership.

But profits aren’t everything, and it’s impossible for the state to determine the best plan for the Mid-coast without comparing proposals side by side.

For that reason, we encourage the state Department of Health and Human Services to reopen a dialogue with Mid Coast — outside the Certificate of Need process — that would lead to a clear-eyed review of both proposals.

Look at the balance sheets, category by category. Assess the administrative capacities. Look at emergency response times. Estimate the secondary effects on employment and real estate. Most importantly, look beyond dollars and bless the merger that gets Mid-coast residents the highest-quality health care, even if it means smaller profits.

Only then can the state — and the people — determine which plan best serves our needs.